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There was one thing that supporters and detractors of former President Barack Obama's health care overhaul agreed on for years: unpopular fines on Americans forgoing coverage were essential for the plan to work because they nudged healthy people to get insured, helping check premiums. Now it turns out that might not be so. (Alonso-Zaldivar, 12/20)

The number of Texans who enrolled in health plans under the besieged Affordable Care Act was down for the coming year but if numbers hold, not as much as feared. Just under 1.1 million Texans signed up for plans or were automatically re-enrolled through the federal exchange for 2019, according to preliminary figures released by the Centers for Medicare and Medicaid Services. That is a drop of about 40,000, or 3.6 percent, from the close of enrollment for 2018. (Deam, 12/20)

The number of Floridians signing up for health insurance through the Affordable Care Act increased this year despite nationwide declines and repeated efforts in Congress and the courts to undercut the program, according to a final enrollment count this week. With nearly 1.8 million people enrolled for 2019, Florida also topped the 39 states who use the federal exchange. (Griffin, 12/20)

In the first open enrollment period since Republicans removed the tax penalty for not having insurance, about 4 percent fewer Americans nationwide chose plans on healthcare.gov than the year before. In Kansas and Missouri, enrollment was down almost 10 percent, leaving advocates concerned that more people may be risking going without coverage. (Marso, 12/20)

Federal health officials announced that the preliminary sign-up number for 2019 coverage was 460,139, about 4 percent lower than the total reached a year ago. The slight year-to-year drop in the state tracked national enrollment trends. (Miller, 12/20)

While enrollment in health exchange plans in Maryland this year was up about 2 percent, there were places where policies were downright hot sellers. Rural counties reported jumps as high as 28 percent from last year. The reason? A “perfect storm” that made some policies sold under the Affordable Care Act the least expensive in the least populated areas. ...Almost 157,000 people signed up in Maryland by Dec. 15, when open enrollment for next year closed. That compares with 8.5 million on the federal exchange, a drop of 3.4 percent, according to preliminary data, that officials attributed to people gaining workplace insurance or Medicaid coverage. (Cohn, 12/21)

Kaiser Health News: Podcast: KHN’s ‘What The Health?’ More On That Texas Lawsuit, And The Best And Worst Health Policy Stories Of The Year

Reaction is still coming in about last week’s federal court ruling that declared the Affordable Care Act unconstitutional. And nearly final numbers for insurance sign-ups at healthcare.gov were surprisingly brisk despite the elimination of the health law’s tax penalty for not having insurance and a dramatically shrunken budget for outreach and enrollment assistance. (12/20)

Arizona Attorney General Mark Brnovich, a plaintiff in the case, is applauding a Texas court judgment invalidating the Affordable Care Act, saying it should be up to Congress to make better health-care policy. The decision from Texas federal court Judge Reed O'Connor in the Texas v. Azar case does not automatically kill the law. The Affordable Care Act, unofficially known as "Obamacare," remains the law of the land. (Innes, 12/20)

California Attorney General Xavier Becerra (D) asked a federal judge on Thursday to block Trump administration rules that would allow more exemptions to ObamaCare's contraception mandate. The final rules, slated to take effect Jan. 14, would allow most businesses to opt out of covering contraception for their employees if they have moral or religious objections. (Hellmann, 12/20)

Kaiser Health News: Short-Term Health Insurance Plans Highly Profitable For Insurers And Brokers

Sure, they’re less expensive for consumers, but short-term health policies have another side: They’re highly profitable for insurers and offer hefty sales commissions. Driven by rising premiums for Affordable Care Act plans, interest in short-term insurance is growing, boosted by Trump administration actions to ease Obama-era restrictions and possibly make federal subsidies available to consumers to purchase them. (Appleby, 12/21)